MAP Keys for Hospitals and Health Systems

The MAP Keys® are strategic key performance indicators (KPIs) that set the standard for revenue cycle excellence in the health care industry. Developed by industry leaders led by HFMA, these industry-standard metrics define the essentials of revenue cycle performance in clear, consistent, and unbiased terms. These strategic keys now apply to acute care hospitals and systems, ambulatory providers, physician organizations, and integrated delivery systems. In other words, there is one set of keys equally applicable to all types of healthcare organizations. There are 29 MAP Keys® (KPIs) for revenue cycle benchmarking divided into 5 major groups. These groups, Patient Access, Pre-Billing, Claims, Account Resolution and Financial Management, reflect the activities represented by the individual keys. An additional unique 6 MAP Keys® have been identified for financial benchmarking within the physician practices only.

In the interest of total transparency and promotion of the keys as the industry strategic benchmarking standard, details of the individual keys have been expanded to include detailed inclusions and exclusions. Details provided mirror the instructions provided for MAP AppSM, HFMA’s web-based benchmarking resource created by and for the industry to improve revenue cycle performance. These definitions also match the definitions used for the metrics portion of the MAP Award for High Performance in Revenue Cycle application.

Data used to calculate the MAP Keys® values is derived from a variety of finance and revenue cycle monthly reports. For each key, the most common source for the data has been included in the definitions document. In many cases, the source will be general ledger account(s), which is the preferred source as these numbers are easily audited and confirmed. Where A/R system or other system reports are used, archived copies of the source materials should be retained for audit and confirmation. Most importantly, unless the processing system changes, the same sources must be used each month.

HFMA recognizes that the implementation of FASB 606 Revenue Recognition rules will impact several MAP Keys® in the reporting of bad debt. Further guidance will be provided as it becomes available.

1Data can be drawn from scheduling systems integrated or a bolt-on to the PFS system

Points of Clarification:

Pre-registered Patient EncountersTotal number of monthly encounters pre-registered prior to scheduled
service. A successful pre-registration is defined as completion of at least
all demographic and insurance data fields, and preferably completion of
all patient demographic, insurance and financial data fields required for
registration as defined by organizational policy. Encounters may be preregistered
in-person, over the phone, or electronically.

Includes:

Outpatient encounters; an outpatient account is defined as one encounter; e.g. a recurring
account counts as one account and one encounter

Inpatient admissions and observation cases (if scheduled in advance)

Urgent care appointments, if scheduled (provider option)

Canceled pre-registrations

Accounts created from any departmental schedule that qualify for pre-registration per
provider policy

1Can be drawn from scheduling systems integrated or bolt-on to the PFS system

Points of Clarification:

Verified EncountersTotal of monthly scheduled encounters that have been verified prior
to or at time of service AND non-scheduled verified encounters. A
successful verification is defined by the individual organization policy.

Includes:

Outpatient encounters - an outpatient account is defined as one encounter; e.g. recurring
account counts as one account and one encounter

Registered EncountersTotal number of registered encounters reported in same reporting month as
numerator. No type of registered encounter is to be excluded from the total -
ALL encounters should be included.

Includes:

Outpatient encounters - an outpatient account is defined as one encounter; e.g. recurring
account counts as one account and one encounter

1Data may be drawn from scheduling systems integrated or bolted-on to the PFS system

Points of Clarification:

Authorized EncountersTotal monthly number of inpatient (IP) and observation (OBS) encounters
that have been authorized prior to claim release. “Authorization” is defined
as medical necessity approval obtained from the third-party payer for
services ordered. A retro-authorization should be counted if completed
before claim is released to the payer.

Encounters Requiring AuthorizationTotal monthly number of inpatient and observation encounters that require
authorization prior to service. “Authorization” is defined as medical
necessity approval obtained from the third-party payer for services
ordered. The denominator data should be calculated as the numerator
(number of authorized encounters) and the number of encounters that
were denied due to a lack of authorization.

1Data may be drawn from scheduling systems integrated or bolted-on to the PFS system

Point of Clarification:

Encounters AuthorizedTotal monthly number of outpatient (OP) encounters that have been
authorized prior to claim release. “Authorization” is defined as medical
necessity approval obtained from the third-party payer for services
ordered. A retro-authorization should be counted if completed before
claim is released to the payer. For the purposes of these keys, authorization
and referral approval are considered the same activity.

Includes:

Series accounts, initial encounter or subsequent encounter where a new authorization
is required

Excludes:

Inpatient and Observation encounters

Encounters Requiring Authorization
Total monthly number of outpatient encounters that require authorization
prior to service. “Authorization” is defined as medical necessity approval
obtained from the third-party payer for services ordered. Data should be
calculated as the numerator (number of authorized encounters) plus the
number of encounters that were denied due to a lack of authorization.

Includes:

Series accounts, initial encounter or subsequent encounter where a new authorization
is required

1Alternative data source is the general ledger transaction code applied to patient
POS cash and the general ledger total for all patient (self-pay) cash collected during
the month

Points of Clarification:

Patient Point-of-Service (POS) Payments

Point-of-service payments are defined as:

Patient cash (self-pay cash) for a current encounter which is collected
prior to, at the time of service, and up to seven days after discharge; and

Patient cash (self-pay cash) for a prior encounter which is collected
prior to or at the time of a new service. Note: Payments on prior
balances do not count as POS if received any time after the time
of a new service; thus, the seven-day window does not apply to
prior balances.

1If only reporting hospital data, physician payments included only for Medicare
recognized hospital-based status clinics; if only reporting physician/ambulatory
payments, exclude hospital payments for non-physician/non-ambulatory payments.
If reporting combined hospital and physician data, report all qualified POS collections.
If reporting at the integrated delivery system level, all self-pay cash
collected across the system is included.

Gross dollars in discharged not final billed (DNFB) = Unbilled A/R
Average daily gross patient service revenue Income Statement

Points of Clarification:

Gross Dollars in Discharged Not Final Billed (DNFB)Gross dollars in A/R for all patient accounts (inpatient and outpatient
accounts) discharged but not yet final billed for the reporting month. Refers
to accounts in suspense (within bill hold days) and pending final billed status
in the patient accounting system.

This is a snapshot at month-end.

Includes:

Recurring accounts (i.e. interim bills) as long as they have been discharged but not final billed

Accounts discharged and held during a system “suspense period”

Ambulatory services charged but not final billed (held in system suspense)

Excludes:

In-house accounts

Accounts in FBNS (Final Billed Not Submitted to Payer)

Average Daily Gross Patient Service RevenueMonthly gross patient service revenue divided by number of days in the
reporting month. This is a single month daily average, not a three-month
rolling average.

Gross Dollars In Final Bill Not Submitted To Payer (FBNS)Gross dollars from initial 837 claims held by edits in claims processing tool
that have not been sent to payer. This is a snapshot at month-end.

Includes:

Initial claims only1

All 837 claims

Claims rejected during submission
process by payer (not denied)

Excludes:

In-house accounts

Accounts in DNFB (Discharged Not
Final Billed); see DNFB Key for definition

Rebills and late charge bills
(based on bill type codes)

1Initial claims are defined as claims never released to the primary payer for adjudication
and payment

Average Daily Gross Patient Service RevenueMonthly gross patient service revenue divided by number of days in the
reporting month. This is a single month daily average, not a three-month
rolling average.

Gross Dollars In DNFB + Gross Dollars In FBNSAutomatically combines DNFB dollars from DNFB (PB-1) and FBNS dollars
from FBNS (PB-2) to calculate the total dollars in claims discharged but not
submitted to the payer

Average Daily Gross Patient Service RevenueMonthly gross patient service revenue divided by number of days
in the reporting month. This is a single month daily average, not a
three-month rolling average.

Σ days from revenue recognition (posting date)

less date of service date (by Charge/CPT code) = Patient Financial System

Σ Count of Chargte/CPT codes billed Patient Financial System

Points of Clarification:

Restricted Use: This key is not to be added to data from accounts, i.e.,
hospital, physician, ambulatory, and/or post-acute that are included in the
data reported in PB-1 and PB-2. If physician, ambulatory and/or post-acute
accounts are not included in PB-1 and PB-2, this key may be used for those
accounts only as a timeliness proxy indicator of charge posting timeliness.

Sum of Days From Revenue Recognition Date Less Date of Service

The number of days between the date of service and the date of revenue
recognition (posting) for each charge code on the claim. This is also known
as the elapsed days between revenue posting date and service date. This is
not a total of the charges but rather a count of days.

Sum of the Count: Charge Codes/CPT Billed

This is a count of the number of charge codes billed, not a summation of
dollars billed

Gross charges with post date
>3 days from service date = Patient Financial System Total gross charges Patient Financial System

Points of Clarification:

Gross Charges With Post Date >3 Days From Service DateAbsolute value of debit and credit charges at transaction level of detail with
a post date greater than 3 days from the service date

Absolute value of late debits + absolute value of late credits = total late
charges; total late charges are not “net” of late charge credits; in other
words, credits are not subtracted from debits

Posting window is service date + 3 days; in other words, if post date
minus service date is greater than 3 days, then it is a late charge; late
charges begin on the 4th day after service date. “Service Date” is
defined as the date a specific service is performed, not the account
date or discharge date.

Charges posted within the month

Excludes charges reclassified based on a change in the assigned
patient type.

Total Gross ChargesTotal gross patient charges for the reporting month

Billed A/R By Aging Category(0-30, 31-60, 61-90, 91-120, > 120 days)Total billed A/R1
amount for all payers in each aging category, aged from
discharge date (inpatient) or date of service (outpatient/ambulatory/physicians).
Aging buckets are mutually exclusive categories and must sum to 100%.

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts; see DNFB Key for definition

In-house accounts

In-house interim-billed accounts

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Billed A/R at the account level; does not include In-house or DNFB2The exclusion applies to the total account balance, not to individual payer and
patient components of the balance. Only if the total account balance is a credit
should it be excluded.

Total Billed A/RTotal billed A/R1 amount for all payers in reporting month, aged from discharge date.

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts; see DNFB Key for definition

In-house accounts

In-house, interim-billed accounts

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Billed A/R at the account level; does not include In-house or DNFB

2The exclusion applies to the total account balance, not to individual payer and patient
components of the balance. Only if the total account balance is a credit should it
be excluded.

Purpose:Trending indicator of receivable collectability
by payer group

Value:Indicates revenue cycle effectiveness at liquidating
A/R by payer group

Equation & Data Source:

Billed A ⁄ R by payer group by
aging category = Aged Trial Balance Total billed A/R by payer group Aged Trial Balance

Points of Clarification:Billed A/R By Payer Group By Aging CategoryTotal billed A/R1
amount by payer in each aging category, aged from discharge
date (hospitals) or date of service (ambulatory/physicians/post acute). Aging
buckets are mutually exclusive categories and must sum to 100%.

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts ; see DNFB Key for definition

In-house accounts

In-house interim-billed accounts not billed at month-end

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Billed A/R at the account level; does not include In-house or DNFB

2The exclusion applies to the total account balance, not to individual payer and
patient components of the balance. Only if the total account balance is a credit
should it be excluded.

Total Billed A/R By Payer GroupTotal billed A/R1
amount by payer in reporting month, aged from discharge
date (hospitals) or date of service (hospitals/ambulatory/physicians).

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts; see DNFB Key for definition

In-house accounts

In-house, interim-billed accounts not billed at month-end

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Billed A/R at the account level; does not include In-house or DNFB

2The exclusion applies to the total account balance, not to individual payer and patient
components of the balance. Only if the total account balance is a credit should it be
excluded.

1Billed A/R = electronic 835/paper source as remit

Points of Clarification:

Number of Claims DeniedTotal claims adjudicated monthly at claim level. Denials are defined as
“actionable denials” - those denials that may be addressed and corrected
within the organization and may result in appropriate reimbursement.

1HFMA may provide generic CARC and group code mappings; providers should
verify applicability by payer; transaction codes may be used to capture individual
actionable denials for reporting and work queue purposes. However, the volume
reported is defined as number of claims, not number of line items denied.

Number of Claims Remitted

Total claims remitted monthly. Remitted claims can be received
electronically or through paper process. If 835 data is not accessible,
use total insurance payment volumes at the account level. Any report that
counts line item detail should not be used; this metric uses the claim as the
correct unit to count.

Points of Clarification:Net Dollars Written Off As DenialsTotal dollars written off as a denial in the reporting month, net of recoveries

Includes:

Denied RAC dollars resulting from lost appeals or choosing not to appeal

Dollars must be stated at net

Average Monthly Net Patient Service RevenueMost recent three-month average1
of total net patient service revenue.
Net patient service revenue is defined as gross patient service revenue
minus contractual allowances, minus charity care provision, then minus the
provision for doubtful accounts. Note: Gross patient service revenue
does not appear on the audited income statement.

Includes:

Medicare Disproportionate Share Hospital (DSH) payments

Medicare IME paid on a MS-DRG basis

Excludes:

Medicaid Disproportionate Share Hospital (DSH)

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Any state or county subsidy, ambulance services, tax and match type assessments, retail
pharmacy, post-acute services and physician practice/clinic unless the clinic is a Medicare
recognized provider-based status clinic. Note: this exclusion does NOT apply to
Integrated Delivery Systems

Bad Debt = Income Statement1Gross patient service revenue Income Statement

1Alternative source is the general ledger transaction(s) as recorded in the allowance/
provision for doubtful accounts G/L account(s

Points of Clarification:

Bad Debt

Total bad debt deduction as shown on the income statement for the
reporting month. This is not the amount written off from A/R. Also called
“Provision for Uncollectible Accounts”, or “Provision for Bad Debt.”

Dollars in credit balance = Aged Trial Balance

Average daily net patient service revenue Income Statement

Points of Clarification:Dollars In Credit Balance Any patient account with a credit balance at the account level, reported
as the absolute value of the credit balance

Excludes:

Pre-service deposits

In-house (not discharged) accounts

Undistributed cash clearing accounts

Average Daily Net Patient Service RevenueMost recent three-month daily average1
of total net patient service
revenue. Net patient service revenue is defined as gross patient service
revenue minus contractual allowances, minus charity care provision, then
minus the provision for doubtful accounts. Note: Gross patient service
revenue does not appear on the audited income statement.

Includes:

Medicare Disproportionate Share Hospital (DSH)

Medicare IME paid on a MS-DRG basis

Excludes:

Medicaid Disproportionate Share Program (DSH)

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Any state or county subsidy, ambulance services, tax and match type assessments, retail
pharmacy, post-acute services and physician practice/clinic unless the clinic is a Medicare
recognized provider-based status clinic. Note: this exclusion does NOT apply to
Integrated Delivery Systems

1Most recent three months is defined as the number of days in the three months
including the last month being reported. For example, data submitted for the three
months ending June 30 includes April (30 days), May (31 days) and June (30 days) for
a total of 91 days used to calculate the average daily net patient service revenue.

Net A/R is the net patient receivable on the balance sheet. It is net of credit
balances, allowances for uncollectible accounts, discounts for charity care,
and contractual allowances for third-party payers.

Includes:

A/R receivables outsourced to third-party company but not classified as bad debt

A/R related to patient specific third-party settlements; a "patient specific settlement" is a payment applied to an individual patient account

CAH payments and settlements

Excludes:

A/R related to non-patient specific third-party settlements; a “non-patient specific
settlement” is payment that is not applied directly to a patient account; it may appear
as a separate, lump sum payment unrelated to a specific account. Examples include
Medicaid Disproportionate Share Hospital (DSH), CRNA, and Direct Graduate Medical
Education (DGME) payments as well as cost report settlements.

Non-patient A/R

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Any state or county subsidy, ambulance services, tax and match type assessments, retail
pharmacy, post-acute services and physician practice/clinic unless the clinic is a Medicare
recognized provider-based status clinic. Note: this exclusion does NOT apply to
Integrated Delivery Systems.

Average Daily Net Patient Service RevenueMost recent three-month daily average of total net patient service
revenue. Net patient service revenue is defined as gross patient service
revenue minus contractual allowances, minus charity care provision, then
minus the provision for doubtful accounts. Note: Gross patient service
revenue does not appear on the audited income statement.

Most recent three months is defined as the number of days in the three
months including the last month being reported. For example, data
submitted for the three months ending June 30 includes April (30 days),
May (31 days) and June (30 days) for a total of 91 days used to calculate
the average daily net patient service revenue.

Includes:

Medicare Disproportionate Share Hospital (DSH) payments

Medicare IME paid on a MS-DRG basis

Excludes:

Medicaid Disproportionate Share Hospital (DSH)

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Any state or county subsidy, ambulance services, tax and match type assessments, retail
pharmacy, post-acute services and physician practice/clinic unless the clinic is a Medicare
recognized provider-based status clinic. Note: this exclusion does NOT apply to
Integrated Delivery Systems

1Net patient service revenue before provision for doubtful accounts is gross patient
service revenue minus contractual allowances, minus charity care provision; under
current accounting guidance, gross revenue does not appear in the financial statements

Average Monthly Net Patient Service RevenueMost recent three-month average of total net patient service revenue.1
Net patient service revenue is defined as gross patient service revenue
minus contractual allowances, minus charity care provision, then minus the
provision for doubtful accounts. Note: Gross patient service revenue
does not appear on the audited income statement.

Includes:

Medicare Disproportionate Share Hospital (DSH) payments

Medicare IME paid on a MS-DRG basis

Excludes:

Medicaid Disproportionate Share Hospital (DSH)

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Any state or county subsidy, ambulance services, tax and match type assessments, retail
pharmacy, post-acute services and physician practice/clinic unless the clinic is a Medicare
recognized provider-based status clinic. Note: this exclusion does NOT apply to
Integrated Delivery Systems

Total patient revenue reported at month-end as “Uninsured Discount”
prior to transfer to bad debt, as shown on income statement for the
reporting month. If patient later qualifies for Charity Care, this discount is
reversed and the Charity Care discount is applied, which should reflect a
reduction in this amount in the month reversed.

Includes:

Any account registered without
insurance, except where
exclusions apply

Sum of relative weights for inpatients = Encoder-Decision Support
Number of discharged inpatients in the month Encoder-Decision Support

Points of Clarification:

Sum of Relative Weights for InpatientsSum of Medicare MS-DRG weights universally applied to all discharged
inpatients for the reporting month1. Only applicable to hospitals and
hospital systems, including hospitals and hospital systems within an
integrated delivery system.

Excludes:

Normal newborns; for hospitals with a NICU, normal newborns will have a revenue code of
UB 0170 or UB 0171 - only these should be excluded

Medicare exempt units; A “Medicare exempt unit” is a unit that does not qualify for
Medicare reimbursement, under IPPS, for example, Medicare IPPS exempt psychiatric
specialty units. Note: this exclusion does NOT apply to Integrated Delivery
Systems unless no MS-DRG assignment is processed.

1Data for the reporting month may be updated until all included cased have been coded
and assigned to a MS-DRG

Discharged Inpatients in the Month

Discharged inpatient count for the reporting month, excluding normal
newborns. Only applicable to hospitals and hospital systems, including
hospitals and hospital systems within an integrated delivery system.

Excludes:

Normal newborns; for hospitals with a NICU, normal newborns will have a revenue code of
UB 0170 or UB 0171 - only these should be excluded

Medicare exempt units; A “Medicare exempt unit” is a unit that does not qualify for
Medicare reimbursement, under IPPS, for example, Medicare IPPS exempt psychiatric
specialty units. Note: this exclusion does NOT apply to Integrated Delivery
Systems unless no MS-DRG assignment is processed.

MAP Award Winner Statistical Data

MAP Keys for Physician Practice Management

The HFMA MAP Keys® Task Force has completed the development of a conforming set of 29 key performance metrics for strategic revenue cycle benchmarking, applicable to all provider types. For MAP App subscribers to the Physician Module, the first 8 MAP Keys to follow are a duplicate of the consolidated list. In addition, the 6 MAP Keys in the “Physician Financial Management” section are to be used exclusively for physician practice data reporting.

Note: HFMA recognizes that the implementation of FASB 606 Revenue Recognition rules will impact several MAP Keys in the reporting of bad debt. Further guidance will be provided as it becomes available.

The below are the definitions for onboarding the PPM Keys. Refer to demographic options within the application for assignment of various comparison criteria.

Number of patient slots occupied = Scheduling System

Number of patient slots available Scheduling System

Points of Clarification:

"Slots" Are Consistent In Size and Defined By the User

The slots reported should represent time attributed as available for
professional and ancillary services provided to patients. Schedule
availability blocked for non-patient care reasons should not be counted.

Number of Patient Slots Occupied

Includes:

The numerator includes overbooked slots, which may increase the
percentage to greater than 100%, which may be accurate. Slots
designated as cancellations and no shows are included in the “occupied”
count unless these designations have been removed and the slot is utilized
for a scheduled service.

Number of Patient Slots Available

Includes:

The actual number of slots available for use during the period being reported.

Patient POS payments = Accounts Receivable

Total self-pay cash collected Accounts Receivable

1Alternative data source is the general ledger transaction code applied to patient POS
cash and the general ledger total for all patient (self-pay) cash collected during the
month

Points of Clarification:

Patient Point-of-Service (POS) Payments

Point-of-service payments are defined as:

1) Patient cash (self-pay cash) for a current encounter which is collected
prior to, at the time of service, and up to seven days after discharge; and

2) Patient cash (self-pay cash) for a prior encounter which is collected
prior to or at the time of a new service. Note: Prior balance
payments received after the current date of service do not
count as POS if received any time after the time of current
service; thus, the seven-day window does not apply to prior
balance payments received after the current date of service.

2If only reporting hospital data, physician payments included only for Medicare
recognized hospital-based status clinics; if only reporting physician/ambulatory
payments, exclude hospital payments for non-physician/non-ambulatory payments. If
reporting combined hospital and physician data, report all qualified POS collections.If reporting at the integrated delivery system level, all self-pay cash
collected across the system is included.

Σ days from service date to

posting date (by Charge/CPT code) = Patient Financial System

Σ Charge/CPT codes billedPatient Financial System

Points of Clarification:

Restricted Use: This key is not to be added to data from accounts, i.e.,
hospital, physician, ambulatory, and/or post-acute that are included in the
data reported in PB-1 and PB-2. If physician, ambulatory and/or post-acute
accounts are not included in PB-1 and PB-2, this key may be used for those
accounts only as a timeliness proxy indicator of charge posting timeliness.

Sum of Days From Service Date (Revenue Recognition Date)
to Charge Posting Date

The number of days between the date of service and the date of revenue
recognition (posting) for each charge code on the claim. This is also known
as the elapsed days between revenue posting date and service date. This is
not a total of the charges but rather a count of days.

Sum of the Count of Charge Codes/CPT billed

This is a count of the number of charge codes billed, not a summation of
dollars billed

0-30, 31-60, 61-90, 91-120, > 120 day = Aged Trial Balance

Total billed A/R Aged Trial Balance

Points of Clarification:

Billed A/R By Aging Category

(0-30, 31-60, 61-90, 91-120, > 120 days)

Total billed A/R1
amount for all payers in each aging category, aged from
discharge date (inpatient) or date of service (outpatient/ambulatory/
physicians). Aging buckets are mutually exclusive categories and must sum
to 100%.

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts; see DNFB Key for definition

In-house accounts

In-house interim-billed accounts

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Billed A/R at the account level; does not include In-house or DNFB

2The exclusion applies to the total account balance, not to individual payer and
patient components of the balance. Only if the total account balance is a credit
should it be excluded.

Billed A/R

Total billed A/R1
amount for all payers in reporting month, aged from
discharge date (hospitals) or date of service (ambulatory/physicians)

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts; see DNFB Key for definition

In-house accounts

In-house, interim-billed accounts

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Billed A/R at the account level; does not include In-house or DNFB

2The exclusion applies to the total account balance, not to individual payer and
patient components of the balance. Only if the total account balance is a credit
should it be excluded.

Billed A/R by payer group by aging category = Aged Trial Balance

Total billed A/R by payer groupAged Trial Balance

Points of Clarification:

Billed A/R By Payer Group By Aging Category

Total billed A/R1
amount by payer in each aging category, aged from
discharge date (hospitals) or date of service (ambulatory/physicians/post
acute). Aging buckets are mutually exclusive categories and must sum to
100%.

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts

In-house accounts

In-house interim-billed accounts not billed at month-end

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Includes in-house and DNFB, billed A/R in standard again categories

2The exclusion applies to the total account balance, not to individual payer and
patient components of the balance. Only if the total account balance is a credit
should it be excluded.

Total Billed A/R By Payer Group

Total billed A/R1
amount by payer in reporting month, aged from discharge
date (hospitals) or date of service (hospitals/ambulatory/physicians).

Includes:

Only active billed debit balance accounts; “active billed accounts” are only those accounts
that are open

Series accounts/recurring accounts

Includes accounts outsourced to a third party but not classified as bad debt accounts, as, for
example, early out accounts and payment plan accounts

Excludes:

Active billed credit balance accounts; these should be removed from the data2

Discharged Not Final Billed (DNFB) accounts; see DNFB Key for definition

In-house accounts

In-house, interim-billed accounts not billed at month-end

Any account not yet billed to the payer or patient (not considered part of billed A/R)

1Billed A/R at the account level; does not include In-house or DNFB

2The exclusion applies to the total account balance, not to individual payer and patient
components of the balance. Only if the total account balance is a credit should it be
excluded.

Indicates provider’s ability to comply with payer
requirements and payers’ ability to accurately pay the
claim; efficiency and quality indicator

Equation and Data Source:

Total number of claims denied = Accounts Receivable1

Total number of claims remitted835 Files and/or Paper Remittance

1Billed A/R = electronic 835/paper source as remit

Points of Clarification:

Number of Claims Denied

Total claims adjudicated monthly at claim level. Denials are defined as
“actionable denials” - those denials that may be addressed and corrected
within the organization and may result in appropriate reimbursement.

Any account not yet billed to the payer or
patient (not considered part of billed A/R)

2HFMA may provide generic CARC and group code mappings; providers should
verify applicability by payer; transaction codes may be used to capture individual
actionable denials or reporting and work queue purposes. However, the volume
reported is defined as number of claims, not number of line items denied.

Number of Claims Remitted

Total claims remitted monthly. Remitted claims can be received electronically
or through paper process. If 835 data is not accessible, use total insurance
payment volumes at the account level. Any report that counts line item detail
should not be used; this metric uses the claim as the correct unit to count.

Net A/R = Balance Sheet

Average daily net patient service revenue Income Statement

Points of Clarification:

Net A/R

Net A/R is the net patient receivable on the balance sheet. It is net of credit
balances, allowances for uncollectible accounts, discounts for charity care,
and contractual allowances for third-party payers.

Includes:

A/R receivables outsourced to third-party company but not classified as bad debt

A/R related to patient specific third-party settlements; a “patient specific settlement” is a
payment applied to an individual patient account

CAH payments and settlements

Excludes:

A/R related to non-patient specific third-party settlements; a “non-patient specific
settlement” is payment that is not applied directly to a patient account; it may appear as a
separate, lump sum payment unrelated to a specific account.

Non-patient A/R

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Any state or county subsidy, ambulance services, tax and match type assessments, retail
pharmacy, post-acute services.

Most recent three-month daily average of total net patient service
revenue. Net patient service revenue is defined as gross patient service
revenue minus contractual allowances, minus charity care provision, then
minus the provision for doubtful accounts. Note: Gross patient service
revenue does not appear on the audited income statement.

Most recent three months is defined as the number of days in the three
months including the last month being reported. For example, data
submitted for the three months ending June 30 includes April (30 days),
May (31 days) and June (30 days) for a total of 91 days used to calculate the
average daily net patient service revenue.

Excludes:

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Total patient service cash collected = General Ledger

Average monthly net patient service revenue Income Statement

Total patient service cash collected for the reporting month, net of refunds

Includes:

All Patient Service payments posted to patient accounts, including undistributed payments

Bad debt recoveries

Excludes:

Non-patient-related settlements/payments; examples: capitation

Non-patient cash; example: retail pharmacy

Average Monthly Net Patient Service Revenue

Most recent three-month average of total net patient service revenue.
Net patient service revenue is defined as gross patient service revenue
minus contractual allowances, minus charity care provision, then minus the
provision for doubtful accounts. Note: Gross patient service revenue
does not appear on the audited income statement.

Most recent three months is defined as the most recent three months
including the last month being reported.

Excludes:

340B drug purchasing program revenue if NOT recognized as a patient receivable in the
patient accounting system

Measures the average profit or loss of primary care
FTE physician on an accrual basis

Value:

Determines the financial health on a physician FTE
level; can be used for tracking and trending the
profitability of the entity based on a physician level;
supports the need for strategy development to
minimize losses

Measures the average profit or loss of a specialty
FTE physician on an accrual basis

Value:

Determines the financial health on a physician FTE
level; can be used for tracking and trending the
profitability of the entity based on a physician level;
supports the need for strategy development to
minimize losses

MAP Keys Compliant Program

HFMA’s MAP Keys Compliant Program evaluates and designates products with data-capture and data-reporting capabilities that support the use of MAP Keys to track, compare, and improve revenue cycle performance.
See the details.